Winning the battle

STRONG support from his family gave Jose Luis Aspiras the strength to fight lymphoma.
A keen badminton player, Jose Luis Aspiras thought he was losing weight because of the many hours he spent on the court as well as his new diet. But when his complexion started turning a dark gray, he realized there was more to it. His family doctor found lumps in his stomach and suggested he get an ultrasound.

The results were far worse than anything he had imagined. “They found tumors in four organs—my liver, my stomach, my lungs and my pancreas,” recalled the retired single businessman and former Mayor of Agoo, a city in the province of Northern Luzon in the Philippines.

Surprisingly, he received the devastating news calmly. “I was in a surrendered state. I just accepted it. There was no emotion. I was 59 at the time,” he explained, “and I felt I had had a good run. I didn’t want to be over-dramatic. I didn’t want to hassle anyone.”

For a month following his diagnosis, he told no one. As his condition worsened, he tried to carry on as normal. “I even played badminton after I found out, just to deflect any thinking.” But he could not keep up the act. “I was declining and the pain was becoming more pronounced and not tolerable anymore.” He decided to plan for the end and choose someone to help him sort out his final wishes.

“I was getting worse and I wanted to make sure that I had somebody at my back, to tide me over.” At a family lunch at his home in Manila, he took his brother-in-law aside and swore him to secrecy, then told him everything. His brother-in-law Mario Oreta was shocked, at first, by the news. Unlike Aspiras though, he refused to accept that there was nothing more to be done and immediately took him to St. Luke’s Hospital in Makati the next morning.

An oncologist ordered a PET-CT scan, which confirmed that Aspiras had cancer. The doctor then ordered a biopsy but this could not be done immediately. The weight of keeping such a big secret, however, bore down heavily on his brother-in-law.

Aspiras said, “He called me in the morning and he said, ‘I can’t do this anymore.’” Oreta asked Aspiras to come over to his house and when he arrived, his sister Babot immediately took charge. “She said: ‘You’re not going anywhere. You’re going to stay with me!’” She called the other sisters, Aida, Cristy, Reggie and Bella, and together, they planned the next course of action.

The next step, a biopsy, was delayed because there was no one at the hospital available to do the procedure. So his sisters went out to talk to everyone they knew for alternative solutions. They met Gina Albert, a long-time cancer survivor, who recommended Dr. Ang Peng Tiam of Parkway Cancer Centre (PCC) in Singapore.

Aspiras’ condition began deteriorating rapidly. “I was flat on the bed. I had just collapsed and all of a sudden I turned yellow.” His family made the decision to go to Singapore. They called PCC and less than 24 hours later they had an appointment with Ang. They were in such a rush to get to Singapore that when they arrived on Sunday afternoon, they had not even booked a hotel. The next morning, October 28, 2010, they were at Ang’s clinic.

Said Ang: “The PET-CT scans done in the Philippines showed that he had an advanced cancer of one form or another. There was literally disease everywhere—in the lymph nodes above and below the diaphragm, both kidneys, the liver, pancreas, lungs and even in various muscles of the body. “I immediately arranged for Aspiras to have a biopsy of the lymph nodes in the abdomen. This was done under direct imaging of the CT scan to ensure that we obtained tissue from the correct site and also ensure that this was done safely.”

A core of the lymph node was dispatched the same day to the pathologist and by the next day, they had confirmed that Aspiras had malignant lymphoma, a primary cancer of the lymph nodes. Treatment began immediately. During his stay of over a month in Singapore, Aspiras’ sisters took turns to come down and help him.

“They absented themselves from work and other responsibilities just to be able to stay with me,” he remembered. He is also grateful to his nephew Tonton Madarang, a nurse who took leave from his job to take care of him, his young nephew Diego who came to see him, and a boyhood friend, Leo Saddam, now living in the US, who stayed with him for a few weeks during the treatment.

Fortunately, he responded well to the treatment. Ang said, “All patients with aggressive lymphoma need to have chemotherapy. One of the ‘tricks’ to keep in mind when treating a patient who is very ill and having a bulky disease, is to start slow. Very often, the doctor treats the disease too aggressively from the word ‘go’ and this puts the patient at risk of dying from the toxicity of the dying cancer cells.”

“By and large, all lymphomas respond well to treatment. The art of caring for a lymphoma patient lies in the management of the immediate side effects caused by rapid death of the lymphoma cells. When the cells die, they can release by-products that can block up the kidneys causing kidney failure. Being aware of these possible side effects allows us to preempt them from occurring by taking the necessary prophylactic measures.”

Aspiras’ cancer is currently in remission. Said Ang: “I remain cautiously optimistic that he’s cured, but one can never be sure until he passes his five-year milestone without any recurrence of his disease.” While the medical care from Ang was crucial, Aspiras believes that his family also played a major role in his recovery.

“Familial love cannot be overstated. When you feel it, it changes you. The moment they (his sisters) took over my condition, they took the cudgels for me. The fight I didn’t have, they gave.” Looking back, Aspiras said he was struck by the difference between how a diagnosis of cancer is seen in Singapore. “In some places, when you have cancer, it’s like the kiss of death. Here, after seeing Ang, it seems like just another activity in their daily calendar and they proceed to do what is next.”